For many years, the MUEs were confidential and were not published. But a couple of years ago, CMS decided they should be made publically available. Although we have published them before and they have not changed, we thought this would be a good time for a reminder.
Code | Description | Medicare and Medicaid MUE |
---|---|---|
95004 | Subcutaneous skin tests/allergenic extracts | 80 |
95012 | Expired Nitric Oxide | 2 |
95017 | Venom skin testing | 27 |
95018 | Skin testing for drugs and biologicals | 19 |
95024 | Intracutaneous tests/allergenic extracts | 40 |
95027 | Intracutaneous sequential and incremental | 90 |
95028 | Intracutaneous/allergenic extracts/delayed reaction | 30 |
95044 | Patch test | 80 |
95076 | Ingestion challenge/initial 120 minutes | 1 |
95079 | Ingestion challenge/each additional hour | 2 |
95144 | Allergy immunotherapy /single dose vials | 30 |
95145 | Venom immunotherapy/1 venom | 10 |
95146 | Venom immunotherapy/2 venoms | 10 |
95147 | Venom immunotherapy/3 venoms | 10 |
95148 | Venom immunotherapy/4 venoms | 10 |
95149 | Venom immunotherapy/5 venoms | 10 |
95165 | Allergen immunotherapy/multi-dose vials | 30 |
95170 | Allergen immunotherapy/whole body extract | 10 |
95180 | Rapid desensitization/each hour | 6 |
For example, if you bill Medicare or Medicaid for more than 80 skin tests on a given day, you may receive a denial. Likewise, a claim with more than 30 doses of allergen immunotherapy (95165) may also trigger a denial. You may want to be aware of these limits when billing Medicare and Medicaid.
It is also important to remember that, for payment purposes, Medicare defines a dose of allergen immunotherapy as one cc of extract. Because Medicaid is a state program, policies vary from state to state. If your state Medicaid plan adopts the same policy on definition of a dose as Medicare, the Advocacy Council may be able to provide guidance for a discussion with Medicaid payers.
For more information on CPT 95165, join our webinar – Everything you wanted to know about 95165 – on Feb. 20 at 7:30 pm CT.